The Swiss approach for a heartbeat-driven lead- and batteryless pacemaker

Abstract

Active medical implants play a crucial role in cardiovascular medicine. Their task is to monitor and treat patients with minimal side effects. Furthermore, they are expected to operate autonomously over a long period of time. However, the most common electrical implants, cardiac pacemakers—as all other electrical implants—run on an internal battery that needs to be replaced before its end of life. Typical pacemaker battery life cycles are in the range of 8–10 years 1 Aizawa Y. Kunitomi A. Nakajima K. Kashimura S. Katsumata Y. Nishiyama T. Kimura T. Nishiyama N. Tanimoto Y. Kohsaka S. Takatsuki S. Fukuda K. Risk factors for early replacement of cardiovascular implantable electronic devices. Int J Cardiol. 2015; 178: 99-101 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ; however, they strongly depend on the device type and usage. Therefore, many patients are confronted with repeated surgical interventions 2 Mond H.G. Proclemer A. The 11th World Survey of Cardiac Pacing and Implantable Cardioverter-Defibrillators: Calendar Year 2009—a World Society of Arrhythmia’s Project. Pacing Clin Electrophysiol. 2011; 34: 1013-1027 Crossref PubMed Scopus (655) Google Scholar that increase the risk of complications such as infections or bleedings 3 Kirkfeldt R.E. Johansen J.B. Nohr E.A. Jørgensen O.D. Nielsen J.C. Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark. Eur Heart J. 2014; 35: 1186-1194 Crossref PubMed Scopus (515) Google Scholar , 4 Polyzos K.A. Konstantelias A.A. Falagas M.E. Risk factors for cardiac implantable electronic device infection: a systematic review and meta-analysis. Europace. 2015; 17: 767-777 Crossref PubMed Scopus (273) Google Scholar , 5 Udo E.O. Zuithoff N.P.A. van Hemel N.M. de Cock C.C. Hendriks T. Doevendans P.A. Moons K.G.M. Incidence and predictors of short- and long-term complications in pacemaker therapy: the FOLLOWPACE study. Heart Rhythm. 2012; 9: 728-735 Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar and are costly. Furthermore, the battery accounts for a majority of a pacemaker’s volume and weight. Its large footprint demands locating conventional pacemakers at a remote pectoral implantation site. Moreover, the large battery is responsible for another major limitation: To deliver the electrical stimulus at the pacing site, conventional pacemakers require long leads. They are exposed to continuous mechanical stress and are prone to fracture. Especially for younger patients this is a critical factor. 6 Fortescue E.B. Berul C.I. Cecchin F. Walsh E.P. Triedman J.K. Alexander M.E. Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm. 2004; 1: 150-159 Abstract Full Text Full Text PDF PubMed Scopus (194) Google Scholar , 7 Odim J. Suckow B. Saedi B. Laks H. Shannon K. Equivalent performance of epicardial versus endocardial permanent pacing in children: a single institution and manufacturer experience. Ann Thorac Surg. 2008; 85: 1412-1416 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar